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Innovative Exercise as an Intervention for Older Adults with Knee Osteoarthritis: A Pilot Feasibility Study

  • Erin M. Shellington (a1), Dawn P. Gill (a2), Ryosuke Shigematsu (a3) and Robert J. Petrella (a2)

Abstract

Exercise has potential to mitigate morbidity in knee osteoarthritis (OA). Participants with knee OA were randomized to a Square-stepping Exercise (SSE) group (2x/week for 24 weeks) or a control group. We assessed the feasibility of SSE and its effectiveness on symptoms (WOMAC), balance (Fullerton), mobility, and walking speed at 12 and 24 weeks. The SSE group had a 49.3% attendance rate and trended toward improvement in the 30-second chair stand at 12 (F = 1.8, p = .12, ηp2 = 0.16), and 24 weeks, (F = 3.4, p = .09, ηp2 = 0.18), and walking speed at 24 weeks, compared to controls. There were no differences in symptoms or balance. The low attendance and recruitment demonstrated limited feasibility of SSE in adults with knee OA. Trends suggest the potential for SSE to improve lower extremity functional fitness and walking speed. SSE should be further studied for effectiveness on symptoms and balance, in addition to improving feasibility.

L’exercice peut diminuer la morbidité associée à l’arthrose du genou. Nous avons réalisé une étude auprès de 22 participants avec arthrose du genou (68 % de femmes) ayant en moyenne 69,5 ans (ÉT : 7,4). Les participants ont été aléatoirement assignés à un groupe d’exercice de marche carrée (square-stepping exercise; SSE; 2 fois/semaine pour 24 semaines) ou à un groupe contrôle. Nous avons évalué la faisabilité (recrutement et présence) du SSE et son efficacité en lien avec les symptômes (WOMAC), l’équilibre (Fullerton), la mobilité (test de la chaise de 30 secondes) et la vitesse de marche après 12 et 24 semaines. Le groupe SSE avait un taux de présence de 49,3% et sa performance au test de la chaise de 30 secondes tendait à s’améliorer après 12 semaines (F=1,8, p=0,12, ηp2=0,16) et 24 semaines (F=3,4, p=0,09, ηp2=0,18), tout comme sa vitesse de marche à 24 semaines (F=2,4, p=0,14, ηp2=0,14), comparativement au groupe contrôle, en contrôlant pour les données de base. Aucune différence n’a été observée sur le plan des symptômes ou de l’équilibre. Les taux de présence et de recrutement faibles indiquent une faisabilité limitée du SSE chez les personnes âgées avec arthrose du genou. Les tendances observées suggèrent que le SSE peut améliorer la fonction du membre inférieur et la vitesse de marche. Les études futures sur le programme SSE devraient se pencher sur son efficacité en lien avec les symptômes et l’équilibre, et viser l’amélioration de sa faisabilité.

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Corresponding author

La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Robert J. Petrella, M.D., Ph.D. Department of Family Medicine Schulich School of Medicine and Dentistry University of Western Ontario 1495 Richmond Street, Rm. 2102 London ON N6G 2M1 (petrella@uwo.ca)

Footnotes

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Funds for this study were provided by Mitacs Accelerate in collaboration with Carbylan Therapeutics Inc. to support graduate students (Author EMS in addition to Ashleigh De Cruz and Brendan Riggin) working on this project. The YMCA and the Salvation Army Community Church (Woodstock, Canada) generously donated the space for study intervention and assessments. We would like to acknowledge the YMCA Stoney Creek in London, Canada, and Vikki Williton (YMCA manager). Additionally, this study could not have been carried out with the assistance of Steve Males (YMCA volunteer), Beth Munro (SSE instructor), and Claire Riley (graduate student with Dr. Robert Petrella). Additional thanks to Ashleigh De Cruz, Brendan Riggin, and Narlon C.B.S. Silva for assistance with data collection, data entry, and program implementation. We acknowledge our Square-stepping Exercise volunteers: Megan Graat, Thomas Petrella, Amy Towell, Nicole Conzelmann, Brendan Dodd, Louise Baer, Sylvia Smith, and Nancy Scott. Lastly, we would like to acknowledge the abstract translation to French by Codie Primeau.

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References

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Abellan Van Kan, G., Rolland, Y., Andrieu, S., Bauer, J., Beauchet, O., Bonnefoy, M., … Vellas, B. (2009). Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people: An international academy on nutrition and aging (IANA) task force. The Journal of Nutrition, Health & Aging, 13(10), 881889. https://doi.org/10.1007/s12603-009-0246-z
Ageberg, E., Link, A., & Roos, E. M. (2010). Feasibility of neuromuscular training in patients with severe hip or knee OA: The individualized goal-based NEMEX-TJR training program. BMC Musculoskeletal Disorders, 11(126), 17.
Alonso, J., Ferrer, M., Gandek, B., Ware, J. E. Jr., Aaronson, N. K., Mosconi, P., … Leplege, A. (2004). Health-related quality of life associated with chronic conditions in eight countries: Results from the International Quality of Life Assessment (IQOLA) Project. Quality of Life Research, 13(2), 283298. https://doi.org/10.1023/B:QURE.0000018472.46236.05
Arthritis Community Research and Evaluation Unit (ACREU). (2015). A profile of arthritis in Canada. Toronto, ON: Author.
Bannuru, R. R., Abariga, S., & Wang, C. (2012). How effective is tai chi mind-body therapy for knee osteoarthritis (KOA)? A systematic review and meta-analysis. Osteoarthritis and Cartilage, 20, Supple, S281–S282. http://dx.doi.org/10.1016/j.joca.2012.02.483
Bellamy, N., Buchanan, W., Goldsmith, C., Campbell, J., & Stitt, L. (1988). Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. Journal of Rheumatology, 15(12), 18331840.
Bennell, K. L., Kyriakides, M., Metcalf, B., Egerton, T., Wrigley, T. V, Hodges, P. W., … Hinman, R. S. (2014). Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment: A randomized controlled trial. Arthritis & Rheumatology, 66(4), 950959. https://doi.org/10.1002/art.38317
Bombardier, C., Hawker, G., & Mosher, D. (2011). The impact of arthritis in Canada: Today and over the next 30 years. Toronto, ON: Arthritis Alliance of Canada. Retrieved from http://www.arthritisalliance.ca
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, R. (1987). A new method of classifying prognostic in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373383. https://doi.org/10.1016/0021-9681(87)90171-8
Cheung, C., Wyman, J. F., Resnick, B., & Savik, K. (2014). Yoga for managing knee osteoarthritis in older women: A pilot randomized controlled trial. BMC Complementary and Alternative Medicine, 14(1), 160. https://doi.org/10.1186/1472-6882-14-160
Cross, M., Smith, E., Hoy, D., Nolte, S., Ackerman, I., Fransen, M., … March, L. (2014). The global burden of hip and knee osteoarthritis: Estimates from the global burden of disease 2010 study. Annals of the Rheumatic Diseases, 73(7), 13231330. https://doi.org/10.1136/annrheumdis-2013-204763
Dobson, F., Bennell, K. L., Hinman, R. S., Abbott, J. H., & Roos, E. M. (2013). Recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis [OARSI funded initiative]. Retrieved from OARSI – Osteoarthritis Research Society International website: https://www.oarsi.org/sites/default/files/docs/2013/manual.pdf
Ebnezar, J., Nagarathna, R., Yogitha, B., & Nagendra, H. R. (2012). Effects of an integrated approach of hatha yoga therapy on functional disability, pain, and flexibility in osteoarthritis of the knee joint: A randomized controlled study. The Journal of Alternative and Complementary Medicine, 18(5), 463472. https://doi.org/10.1089/acm.2010.0320
Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee: A Cochrane systematic review. British Journal of Sports Medicine, 49(24), 15541557. https://doi.org/10.1136/bjsports-2015-095424
Goble, D. J., Coxon, J. P., Van Impe, A., Geurts, M., Doumas, M., Wenderoth, N., & Swinnen, S. P. (2011). Brain activity during ankle proprioceptive stimulation predicts balance performance in young and older adults. Journal of Neuroscience, 31(45), 1634416352. https://doi.org/10.1523/JNEUROSCI.4159-11.2011
Jindo, T., Kitano, N., Tsunoda, K., Kusuda, M., Hotta, K., & Okura, T. (2017). Daily life physical activity modulates the effects of an exercise program on lower-extremity physical function in Japanese older adults. Journal of Geriatric Physical Therapy, 40(3), 150157. https://doi.org/10.1519/JPT.0000000000000087
Jindo, T., Tsunoda, K., Kitano, N., Tsuji, T., Abe, T., Muraki, T., … Okura, T. (2016). Pedometers affect changes in lower-extremity physical function during a square-stepping exercise program in older Japanese adults. Journal of Geriatric Physical Therapy, 39(2), 8388. https://doi.org/10.1519/JPT.0000000000000054
Jones, C. J., Rikli, R. E., & Beam, W. C. (1999). A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Research Quarterly for Exercise and Sport, 70(2), 113119. https://doi.org/10.1080/02701367.1999.10608028
Kan, L., Zhang, J., Yang, Y., & Wang, P. (2016). The effects of yoga on pain, mobility, and quality of life in patients with knee osteoarthritis: A systematic review. Evidence-Based Complementary and Alternative Medicine. Article ID 6016532, 10 pp. https://doi.org/10.1155/2016/6016532
Lachin, J. (1981). Introduction to sample size determination and power analysis for clinical trials. Controlled Clinical Trials, 2(2), 93113.
Lagace, C., Perrucio, A., Degano, C., Nichol, M., Ansari, H., Badley, E., … Tyas, J. (2010). Life with Arthritis in Canada: A personal and public health challenge. Ottawa, ON: Public Health Agency of Canada.
Lam, H. S. P., Lau, F. W. K., Chan, G. K. L., & Sykes, K. (2010). The validity and reliability of a 6-metre timed walk for the functional assessment of patients with stroke. Physiotherapy Theory and Practice, 26(4), 251255. https://doi.org/10.3109/09593980903015235
Mack, R., Salmoni, A., Viverais-Dressler, G., Porter, E., & Garg, R. (1997). Perceived risks to independent living: The views of older, community-dwelling adults. The Gerontologist, 37(6), 729736. https://doi.org/10.1093/geront/37.6.729
McAlindon, T. E., Bannuru, R. R., Sullivan, M. C., Arden, N. K., Berenbaum, F., Bierma-Zeinstra, S. M., … Underwood, M. (2014). OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage, 22(3), 363388. https://doi.org/10.1016/j.joca.2014.01.003
Myers, A. M., Fletcher, P. C., Myers, A. H., & Sherk, W. (1998). Discriminative and evaluative properties of the Activities-specific Balance Confidence (ABC) Scale. Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 53A(4), M287M294. https://doi.org/10.1093/gerona/53A.4.M287
Pai, Y. I. C., Rymer, W. Z., Chang, R. W., & Sharma, L. (1997). Effect of age and osteoarthritis on knee proprioception. Arthritis and Rheumatism, 40(12), 22602265. https://doi.org/10.1002/art.1780401223
Paker, N., Bugdayci, D., Demircioglu, U. B., Sabirli, F., & Ozel, S. (2017). Reliability and validity of the Turkish version of Activities-specific Balance Confidence scale in symptomatic knee osteoarthritis. Journal of Back and Musculoskeletal Rehabilitation, 30(3), 461466. https://doi.org/10.3233/BMR-150335
Petrella, R. J., Koval, J. J., Cunningham, D., & Paterson, D. H. (2001). A self-paced step test to predict aerobic fitness in older adults in the primary care clinic. Journal of the American Geriatrics Society, 49(5), 632638. https://doi.org/10.1046/j.1532-5415.2001.49124.x
Petrella, R. J., & Wight, D. (2000). An office-based instrument for exercise counseling and prescription in primary care. The Step Test Exercise Prescription (STEP). Archives of Family Medicine, 9(4), 339344. https://doi.org/10.1001/archfami.9.4.339
Podsiadlo, D., & Richardson, S. (1991). The Timed “Up & Go”: A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2), 142148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
Powell, L. E., & Myers, A. M. (1995). The Activities-specific Balance Confidence (ABC) Scale. Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 50A(1), M28M34. https://doi.org/10.1093/gerona/50A.1.M28
Public Health Agency of Canada’s Population Health Economics Team. (2014). Economic burden of illness in Canada, 2005–2008. Ottawa, ON: Public Health Agency of Canada. Retrieved from http://www.phac-aspc.gc.ca/publicat/ebic-femc/2005-2008/assets/pdf/ebic-femc-2005-2008-eng.pdf
Rose, D. J., Lucchese, N., & Wiersma, L. D. (2006). Development of a multidimensional balance scale for use with functionally independent older adults. Archives of Physical Medicine and Rehabilitation, 87(11), 14781485. https://doi.org/10.1016/j.apmr.2006.07.263
Rydwik, E., Bergland, A., Forsen, L., & Frandin, K. (2012). Investigation into the reliability and validity of the measurement of elderly people’s clinical walking speed: A systematic review. Physiotherapy Theory and Practice, 28(3), 238256. https://doi.org/10.3109/09593985.2011.601804
Scherf, K. S., Sweeney, J. A., & Luna, B. (2006). Brain basis of developmental change in visuospatial working memory. Journal of Cognitive Neuroscience, 18(7), 10451058. https://doi.org/10.1162/jocn.2006.18.7.1045
Shellington, E. M., Felfeli, T., Shigematsu, R., Gill, D. P., & Petrella, R. J. (2017). HealtheBrain: An innovative smartphone application to improve cognitive function in older adults. mHealth, 3(17), 17. https://doi.org/10.21037/mhealth.2017.04.05
Shigematsu, R., & Okura, T. (2006). A novel exercise for improving lower-extremity functional fitness in the elderly. Aging Clinical and Experimental Research, 18(3), 242248.
Shigematsu, R., Okura, T., Nakagaichi, M., Tanaka, K., Sakai, T., Kitazumi, S., & Rantanen, T. (2008). Square-stepping exercise and fall risk factors in older adults: A single-blind, randomized controlled trial. Journal of Gerontology: Medical Sciences, 63A(1), 7682.
Shigematsu, R., Okura, T., Sakai, T., & Rantanen, T. (2008). Square-stepping exercise versus strength and balance training for fall risk factors. Aging Clinical and Experimental Research, 20, 1924.
Skou, S. T., Odgaard, A., Rasmussen, J. O., & Roos, E. M. (2012). Group education and exercise is feasible in knee and hip osteoarthritis. Danish Medical Journal, 59(12), 15.
Skou, S. T., & Roos, E. M. (2017). Good life with osteoArthritis in Denmark (GLA: D™): Evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskeletal Disorders, 18(72), 113. https://doi.org/10.1186/s12891-017-1439-y
Sprangers, M. A. G., de Regt, E. B., Andries, F., van Agt, H. M. E., Bijl, R. V., de Boer, J. B., … de Haes, H. C. J. M. (2000). Which chronic conditions are associated with better or poorer quality of life? Journal of Clinical Epidemiology, 53(9), 895907. https://doi.org/10.1016/S0895-4356(00)00204-3
Takacs, J., Carpenter, M. G., Garland, S. J., & Hunt, M. A. (2013). The role of neuromuscular changes in aging and knee osteoarthritis on dynamic postural control. Aging and Disease, 4(2), 8499. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3659254&tool=pmcentrez&rendertype=abstract
Teixeira, V. C. L., Gobbi, S., Pereira, J. R., Ueno, D. T., Shigematsu, R., & Gobbi, L. T. B. (2013). Effect of square-stepping exercise and basic exercises on functional fitness of older adults. Geriatrics and Gerontology International, 13, 842848. https://doi.org/10.1111/ggi.12011
Verghese, J., Lipton, R. B., Katz, M. J., Hall, C. B., Derby, C. A., Kuslansky, G., … Buschke, H. (2003). Leisure activities and the risk of dementia in the elderly. New England Journal of Medicine, 348(25), 25082516. https://doi.org/10.1056/NEJMoa022252
Wilkie, R., Peat, G., Thomas, E., & Croft, P. (2007). Factors associated with restricted mobility outside the home in community-dwelling adults ages fifty years and older with knee pain: An example of use of the International Classification of Functioning to investigate participation restriction. Arthritis and Rheumatism, 57(8), 13811389. https://doi.org/10.1002/art.23083

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